Provider Demographics
NPI:1063422863
Name:VEDDER, TRACY JASON (DC)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:JASON
Last Name:VEDDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CASTILLO ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3406
Mailing Address - Country:US
Mailing Address - Phone:805-453-4158
Mailing Address - Fax:805-568-1680
Practice Address - Street 1:510 CASTILLO ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3406
Practice Address - Country:US
Practice Address - Phone:805-453-4158
Practice Address - Fax:805-568-1680
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23606OtherSTATE LICENSE